838
Asian Pac J Trop Biomed 2014; 4(10): 838-840
Contents lists available at ScienceDirect
Asian Pacific Journal of Tropical Biomedicine journal homepage: www.elsevier.com/locate/apjtb
Document heading
doi:10.12980/APJTB.4.2014APJTB-2014-0012
Disseminated
襃 2014
by the Asian Pacific Journal of Tropical Biomedicine. All rights reserved.
toxocariasis in an immunocompetent host
1
1
2
3
1*
Madan Raj Aryal , Paras Karmacharya , Amrit Pokharel , Smith Giri , Ranjan Pathak
, Richard Alweis1
Department of Medicine, Reading Health System, PA 19611, USA
1
Department of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
2
Department of Medicine, University of Tennessee Health Science Center, TN 38163, USA
3
PEER REVIEW
ABSTRACT
Peer reviewer D r. L im B oon H uat, B iomedicine Programme, School of Health Sciences, H ealth C ampus, U niversiti S ains M alaysia, 16150 K ubang K erian, Kelantan, Malaysia. Tel: +6 09767 7619, Fax: +6 09767 7515, E-mail: limbh@
Toxocariasis is a zoonotic infection caused by Toxocara canis, or less commonly, Toxocara cati, which is one of the most common zoonotic infections worldwide. It commonly affects the pediatric and immunocompromised population; however, it has rarely been reported in the immunocompetent adults. Two of the well-recognized syndromes in children are visceral larva migrans and ocular larva migrans. Infection in adults usually ranges from asymptomatic to nonspecific symptoms which makes the diagnosis challenging. A case of 36 year-old male was presented with disseminated toxocariasis with pulmonary and hepatic involvement and striking peripheral eosinophilia.
usm.my Co-reviewers: Prof. Fabrizio Bruschi, Pisa, Italy.
Comments The authors demonstrated the efficacy
of albendazole or mebendazole with concomitant corticosterioid on treating a patient suspected of being infected with toxocariasis.
Details on Page 840
KEYWORDS Toxocariasis, Toxocara canis, Mebendazole, Albendazole
1. Introduction
striking peripheral eosinophilia.
Toxocariasis is a human infiltrative larval infection caused by the dog ascarid, Toxocara canis and the cat ascarid, Toxocara cati[1]. Human toxocariasis is one of the most common zoonotic infections worldwide. While it is more common in the tropical regions of the world; it is estimated that human seroprevalence is 13.9% in the United States and that about 5% of dogs and puppies in North America are infected[2,3]. It commonly affects the pediatric and immunocompromised population; however, it has rarely been reported in the immunocompetent adults. Infection in adults usually ranges from asymptomatic to non-specific symptoms which makes the diagnosis challenging. A case of 36 year-old male was presented with disseminated toxocariasis with pulmonary and hepatic involvement and
A 36 year-old Caucasian male presented to the emergency department with low grade fever, fatigue and abdominal pain for 1 week. The pain was intermittent, lasting several minutes at a time, localized to the right upper quadrant with no aggravating or alleviating factors. A ssociated symptoms included nausea with 5 episodes of non-bilious vomiting and nonproductive cough for the same duration. Social history included living in an apartment with 6 dogs and a kitten. He also had prior exposure to tuberculosis. He denied any recent travel outside Pennsylvania, ingestion of raw or uncooked meat, or recent sick contacts.
*Corresponding author: Ranjan Pathak, MD, Department of Internal Medicine, Reading Health System, West Reading, PA 19611, USA. Tel: 1 484 8183401 Fax: 1 484 6289003 E-mail:
[email protected]
Article history: Received 6 Jan 2014 Received in revised form 10 Feb, 2nd revised form 22 Feb, 3rd revised form 8 Mar 2014 Accepted 26 Apr 2014 Available online 15 Sep 2014
2. Case presentation
Madan Raj Aryal et al./Asian Pac J Trop Biomed 2014; 4(10): 838-840
A
839
B
Figure 1. Contrast enhanced CT scan of the chest and abdomen. A: CT scan of the chest showing multifocal, ill-defined pulmonary nodules with a small surrounding halo, without evidence of cavitation; B: CT scan of the abdomen showing multiple sub-centimeter ill-defined hypodense lesions with vague peripheral enhancement throughout the liver.
Physical examination revealed a fully conscious and alert patient with a blood pressure of 128/76 mmHg, pulse rate 76/min, respiratory rate 20/min, and a temperature of 36.8 °C. The lungs were clear to auscultation bilaterally. H e had mild right upper quadrant tenderness with no guarding, rigidity or rebound tenderness. Stool guaiac test was negative for occult blood. His laboratory test results were significant for a leukocytosis with white blood cell count 17 400/mm3 (eosinophils 18%, absolute eosinophil count 3 220), hemoglobin 14.4, blood glucose 99 and his aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, amylase, lipase and bilirubin were all within normal limits. S erum immunoglobulin ( Ig ) E levels were 5564 IU/mL, other immunoglobulin levels (IgA, G and M) as well as complement levels (CH50) were within normal limits. Flow cytometry did not reveal any abnormal cell populations. Additional tests, including antinuclear antibody, anti-neutrophil cytoplasmic antibody, stool examination for ova and parasites, serologies for HIV , hepatitis B and C , Aspergillus fumigatus, Trichinella spiralis, Histoplasma capsulatum, Toxoplasma gondii, Strongyloides stercoralis and quantiferon test were all negative. His serum toxocara IgM antibody levels on ELISA was 3.19 (normal
